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General NPI Number Information
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NPI Number | 1255436077
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Entity Type | Individual
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Provider Name | BRIAN CHARLES DELLA PESCA LPC
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 654 AVENUE C 2ND FLOOR
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City | BAYONUE
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State | NJ
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Zip | 07002
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Country | US
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Telephone | 973-980-2955
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Fax | 201-436-1601
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Provider Business Mailing Address
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Address Line | PO BOX 271
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City | HAWTHORNE
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State | NJ
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Zip | 07507
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Country | US
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Telephone | 973-980-2955
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Fax | 201-436-1601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | NJPC000331
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License Number State | NJ
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